Magnitude of Neural Tube Defects and Associated Risk Factors at Three Teaching Hospitals in Addis Ababa, Ethiopia

Abstract

There is scarcity of data on prevalence of neural tube defects (NTDs) in lower-income countries. Local data are important to understand the real burden of the problem and explore risk factors to design and implement preventive approaches. This study aimed to determine prevalence and risk factors of NTDs. A hospital-based cross-sectional and unmatched case-control study was conducted at three teaching hospitals of Addis Ababa University. NTDs were defined as cases of anencephaly, spina bifida, and encephalocele based on ICD-10 criteria. The prevalence of NTDs was calculated per 10,000 births for both birth and total prevalence. During seven months, we observed 55 cases of NTDs out of 8677 births after 28 weeks of gestation—birth prevalence of 63.4 per 10,000 births (95% confidence interval (CI), 51–77). A total of 115 cases were medically terminated after 12 weeks of gestation. Fifty-six of these terminations (48.7%) were due to NTDs. Thus, total prevalence of NTDs after 12 weeks' gestation is 126 per 10,000 births (95% CI, 100–150). Planned pregnancy (adjusted odds ratio (aOR), 0.47; 95% CI, 0.24–0.92), male sex (aOR, 0.56; 95% CI, 0.33–0.94), normal or underweight body mass index (aOR, 0.49; 95%, 0.29–0.95), and taking folic acid or multivitamins during first trimester (aOR, 0.47; 95%, 0.23–0.95) were protective of NTDs. However, annual cash family income less than $1,300 USD (aOR, 2.5; 95%, 1.2–5.5), $1,300–1,800 USD (aOR, 2.8; 95%, 1.3–5.8), and $1,801–2,700 USD (aOR, 2.6; 95%, 1.2–5.8) was found to be risk factors compared to income greater than $2,700 USD. The prevalence of NTDs was found to be high in this setting. Comprehensive preventive strategies focused on identified risk factors should be urgently established. More studies on prevention strategies, including folic acid supplementations, should be conducted in the setting.

High burden of neural tube defects in Tigray, Northern Ethiopia: Hospital-based study

“…The highest burden of NTDs was observed in Adigrat Hospital from Eastern Zone (174 per 10,000 live and stillbirths) and southern zone of Tigray (304 per 10,000 live and stillbirth). Similar findings were reported from prospective studies of births at three teaching hospitals in Addis Ababa, Ethiopia with 126 per 10,000 births [ 19 ]. Folate deficiency is widespread in Ethiopia.…”

Magnitude and Associated Factors of Neural Tube Defects in Ethiopia: A Systematic Review and Meta-Analysis

“…Most of the studies were conducted in the central and northern part of the country. All studies were cross-sectional studies 23,24,26,27,29,31,[37][38][39] except a cohort study conducted in Tigray. 36 All of the studies were conducted Abbreviations: OR, odds ratio; CI, confidence interval; BMI, body mass index; NA, not applicable; DD, dietary diversity; BF, breast feeding; PX, pregnancy.…”

“…24 It is also stated in other primary surveys in Ethiopia that there are sizeable numbers of pregnancies associated with NTDs. 20,[25][26][27][28][29][30][31][32] These findings are inconsistent and inconclusive for policy makers and stakeholders. Therefore, the pooled prevalence, patterns, and risk factors for NTDs in Ethiopia were explored in this systematic review and meta-analysis.…”

Congenital anomalies following antenatal exposure to dolutegravir: a Canadian surveillance study

“…The incidence of NTDs in Canada is approximately 4 per 10 000 live births; this decreased from 7.6 per 10 000 births following the initiation of folate fortification of grain products in 1998 to prevent folate‐deficiency‐related NTDs . Although data are limited, studies globally have shown substantial geographic variability in rates of NTDs from 5.2 per 10 000 live births to more than 120 per 10 000 live births in African countries …”